CTICasesPaget-Schroetter Syndrome (Effort Thrombosis of the Subclavian Vein)
Imaging findings
Venography in a mountain climber shows mild narrowing of the subclavian vein where it crosses the first rib on an early view; after arm manipulation, a repeat study shows markedly worsened obstruction with essentially no flow across the subclavian vein.
Key takeaways
This is Paget-Schroetter syndrome, effort-induced thrombosis of the subclavian vein related to muscular hypertrophy and repetitive positional compression at the thoracic outlet, classically seen in athletes such as climbers and pitchers who load the arm and shoulder girdle. Treatment often requires first-rib resection to decompress the thoracic outlet, and this remains a favorite board-style diagnosis to recognize.
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